A multicenter survey of temporal changes in chemotherapy-induced hair loss in breast cancer patients

Materials and methods

We conducted a multicenter, cross-sectional questionnaire survey. Breast cancer patients who had completed adjuvant chemotherapy regimens were recruited from hospitals and clinics in Japan from April to October 2013. The following subjects were considered to meet the inclusion criteria; 1) Breast cancer patients who had completed adjuvant chemotherapy regimens containing anthracycline and/or taxanes within the prior 5 years, 2) Disease-free patients, 3) Patients who are living in Japan and able to understand Japanese, 4) Patients 20 years of age or older. There were no exclusion criteria.

The questionnaire was developed for this survey based on the opinions of members of our Working Group. We initially solicited questions from each member. Items related to scalp hair, head coverings, eyebrows / eyelashes, nails and the severity of side effects were collected. Regarding the severity of side effects, we chose items based on reports in the relevant literature [8–10]. After several meetings, we reached consensus and finalized the questionnaire (S1 Fig (Japanese version), S2 Fig (English version)). It contained 65 questions concerning the patients’ perceptions of physical and non-physical side effects (15 questions) and chemotherapy-induced hair loss or appearance issues (50 questions). The 50 questions concerning chemotherapy-induced hair loss or appearance issues were about scalp hair (13 questions), eyebrows (2), eyelashes (2), nails (4), equipment used such as wigs and caps (13), information acquisition (8), and the use of makeup (8). In this questionnaire, we asked about the conditions of scalp hair, eyebrows, eyelashes and nails at 3 different time points: before chemotherapy, 6 months after the beginning of scalp hair regrowth, and at the time of filling out the questionnaire survey.

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At the outpatient clinic, the attending physician explained this research to the patients. They then filled out the first page of the questionnaire, writing the medicines that they had been administered. The patients were given the questionnaires and returned home with them. Only patients who agreed to participate in the study mailed the questionnaire directly to the data center after responding to the items surveyed. Descriptive statistics were obtained in this study. The Kaplan-Meier method was used to plot graphs of the wig usage period. Since some patients did not respond to all items, the total number of responses differed among items. In this study, the temporal changes in hair regrowth and nail condition were analyzed using patient groups classified according to number of years after completing chemotherapy.

Ethics approval was given by the ethics committee of Sendai Medical Center. Furthermore, the institutional review boards or the ethics committees of the 46 facilities participating in this survey (please see Acknowledgments below) approved this questionnaire survey. Since this trial did not use human biological specimens, written informed consent was not required according to the ethical guidelines for epidemiological research in Japan (Ministry of Health, Labour and Welfare, Japan. 2012) [11]. However, verbally-provided informed consent was required for this study. An explanatory document pertaining to this study was given to the patients with a brief explanation. Verbally-provided informed consent was documented in each patient’s medical chart. Patients who did not agree to participate in the study did not mail in the questionnaire form. The study is reported according to the STROBE criteria [12].

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About the Author: Tung Chi